Provider Demographics
NPI:1851509335
Name:LO, KWOK CHU TERESA
Entity Type:Individual
Prefix:
First Name:KWOK CHU
Middle Name:TERESA
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 MILLER LAKE RD.
Mailing Address - Street 2:
Mailing Address - City:CULLEOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38451
Mailing Address - Country:US
Mailing Address - Phone:931-379-7500
Mailing Address - Fax:
Practice Address - Street 1:5156 MILLER LAKE ROAD
Practice Address - Street 2:
Practice Address - City:CULLEOKA
Practice Address - State:TN
Practice Address - Zip Code:38451
Practice Address - Country:US
Practice Address - Phone:931-379-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist